AUTHOR=von Stein Philipp , Seitz Lukas , Wienemann Hendrik , Hohmann Christopher , Baar Till , Baldus Stephan , Halbach Marcel 

TITLE=Early in-hospital discontinuation of aspirin on the first post-procedural day after percutaneous coronary stent implantation in patients on direct oral anticoagulation

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=10

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1265452

DOI=10.3389/fcvm.2023.1265452

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>Previous trials investigating antithrombotic therapy with a direct oral anticoagulant (DOAC) and a P2Y12 inhibitor after percutaneous coronary intervention (PCI), termed dual therapy, allowed a short period of triple therapy including a DOAC, a P2Y12 inhibitor, and aspirin.</p></sec><sec><title>Aims</title><p>This study aimed to determine whether discontinuation of aspirin on the first post-procedural day is safe or causes ischemic events.</p></sec><sec><title>Methods</title><p>Ischemic and bleeding events during hospitalization were investigated retrospectively in all patients treated with dual therapy (DOAC + P2Y<sub>12</sub> inhibitor, designated as group 1) or triple therapy (DOAC + P2Y<sub>12</sub> inhibitor+aspirin, designated as group 2) from day 1 after PCI at our center.</p></sec><sec><title>Results</title><p>Of 4,564 consecutive PCI procedures, 1,059 (23.2%) had an indication for OAC. Of these, 322 met the inclusion criteria for group 1 and 62 for group 2. Baseline characteristics, CHA<sub>2</sub>DS<sub>2</sub>-VASc and HAS-BLED scores showed no relevant differences between the two groups, and the main indication for DOAC therapy was atrial fibrillation in both groups. Approximately ¼ of patients were treated for acute coronary syndrome. The mean length of post-procedural hospitalization was 2.1 ± 2.5 and 2.2 ± 3.0 days in group 1 and 2, respectively (<italic>p</italic> = 0.305). One patient per group suffered a TIA (<italic>p</italic> = 0.297). There were no other ischemic events and no statistically significant differences in bleeding events. A subgroup analysis of cases hospitalized for ≥2 post-procedural days (group 1: 100 cases, mean 4.4 ± 3.4 days vs. group 2: 25 cases, mean 4.0 ± 4.1 days) confirmed these results.</p></sec><sec><title>Conclusion</title><p>The initiation of dual therapy and thus discontinuation of aspirin on the first postprocedural day appears to be safe with respect to short-term ischemic events in a real-world population. Almost ¼ of patients undergoing PCI have an indication for OAC, highlighting the relevance of this issue.</p></sec>